Fibrocystic Breast Disease

September 11, 2011

Fibrocystic breast disease, better called “fibrocystic changes,” are common changes that affect most women, especially during the reproductive years. Approximately 60% of women will experience some symptoms related to fibrocystic breasts. Single or multiple benign tumors may be present, or a woman may just note general “lumpiness” in her breasts. Usually symptoms are worse prior to menses, but they may occur during any part of the cycle. After menopause, especially if women are not taking any hormone replacement therapy (HRT), symptoms usually lessen or disappear.

Fibrocystic changes are diagnosed primarily by history and physical examination. Breast cysts, which may be part of fibrocystic changes, may be noted on breast self-exam, or physical exam by a health care provider. A breast cyst is a fluid-filled space that is lined with glandular cells and may become large and painful. An
ultrasound and/or breast aspiration can usually prove the diagnosis. In general, mammography does not have a role in diagnosing fibrocystic changes, and most importantly, fibrocystic changes do not increase a woman’s risk of breast cancer.

Treatment of fibrocystic changes is aimed at relieving a woman’s symptoms of pain and discomfort. Avoiding coffee, tea, caffeine, and chocolate is often recommended to relieve symptoms, but this is not supported by scientific data. Vitamins, calcium, birth control pills, diuretics, or “water pills” (particularly spironolactone), and a testosterone derivative, Danocrine, have all been used to relieve the symptoms of fibrocystic changes.

A woman with fibrocystic breast changes who finds a lump should still have the lump evaluated. A breast lump may be evaluated initially by fine needle aspiration. If the lump is aspirated and clear cyst fluid is obtained, then no further evaluation needs to be done. However, if a lump cannot be aspirated in the office, then often an ultrasound or ultrasound-guided aspiration will be attempted. If the lump is found to be solid, then it may need to be biopsied.

A solitary lump, particularly if found in an older woman, needs to be evaluated for possible breast cancer. If the breast biopsy is benign, in general, no further treatment is needed.

A solid lump, especially in a very young woman, is likely to be a fibroadenoma. A fibroadenoma is a solid, benign tumor that can grow very large, and is usually found in women who are in their teens or early 20s. They do not necessarily have to be removed, but many women choose to have these excised to avoid confusion about the possibility of cancer later in life.

While fibrocystic changes, per se, do not increase the risk of breast cancer, a biopsy showing hyperplasia, which is excessive cell growth, indicates a slightly increased risk of breast cancer. If these cells are both hyperplastic and atypical, then she has a risk of breast cancer that is higher yet.

As menopause approaches, many women who have had fibrocystic breast changes during their reproductive years may become more concerned about breast cancer. Even in women with fibrocystic changes, the recommendation for mammography remains the same. Mammography should be performed every 1-2 years during a woman’s 40s and yearly after age 50.

In summary, it is important to emphasize that fibrocystic breast changes are not a disease and are common in most women of reproductive age.

SEE ALSO: Mammography

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